Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-23T06:09:24.984Z Has data issue: false hasContentIssue false
  • English
  • Français

Caregiver rating bias in mild cognitive impairment and mild Alzheimer's disease: impact of caregiver burden and depression on dyadic rating discrepancy across domains

Published online by Cambridge University Press:  07 May 2013

Livia Pfeifer ,
Reinhard Drobetz ,
Sonja Fankhauser ,
Moyra E. Mortby ,
Andreas Maercker  and
Simon Forstmeier
Livia Pfeifer*
Affiliation:
Institute of Psychology, Division Psychopathology and Clinical Intervention, University of Zurich, Binzmühlestr. 14/17, 8050 Zurich, Switzerland
Reinhard Drobetz
Affiliation:
Institute of Psychology, Division Psychopathology and Clinical Intervention, University of Zurich, Binzmühlestr. 14/17, 8050 Zurich, Switzerland
Sonja Fankhauser
Affiliation:
Institute of Psychology, Division Psychopathology and Clinical Intervention, University of Zurich, Binzmühlestr. 14/17, 8050 Zurich, Switzerland
Moyra E. Mortby
Affiliation:
Centre for Research on Ageing, Health and Wellbeing, Australian National University, Eggleston Road, Canberra, ACT 0200, Australia
Andreas Maercker
Affiliation:
Institute of Psychology, Division Psychopathology and Clinical Intervention, University of Zurich, Binzmühlestr. 14/17, 8050 Zurich, Switzerland
Simon Forstmeier
Affiliation:
Institute of Psychology, Division Psychopathology and Clinical Intervention, University of Zurich, Binzmühlestr. 14/17, 8050 Zurich, Switzerland
*
Correspondence should be addressed to: Livia Pfeifer, MSc, Institute of Psychology, Division Psychopathology and Clinical Intervention, University of Zurich, Binzmühlestr. 14/17, 8050 Zurich, Switzerland. Phone: +41 44 635 73 26; Fax: +41 44 635 73 19. Email: l.pfeifer@pychologie.uzh.ch.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Caregivers of individuals with dementia are biased in their rating of mental health measures of the care receiver. This study examines caregiver burden and depression as predictors of this bias for mild cognitive impairment and mild Alzheimer's disease in different domains.

Methods: The sample consisted of 202 persons: 60 with mild cognitive impairment, 41 with mild Alzheimer's disease, and 101 caregivers. Discrepancy scores were calculated by subtracting the mean caregiver score from the respective mean patient score on the following assessment instruments: the Geriatric Depression Scale, Apathy Evaluation Scale, Bayer-Activities of Daily Living Scale, and Quality of Life-AD scale. Caregiver burden and depression were assessed by the Zarit Burden Interview and the Center for Epidemiologic Studies Depression Scale.

Results: Intraclass correlation coefficients were low for apathy (0.38), daily functioning (0.38), and quality of life (0.30) and moderate for depression (0.49). These domains showed negative rating discrepancies, which indicates caregiver rating bias for all four domains. Regression analyses revealed that caregiver burden significantly contributed to explaining these discrepancies in the domains apathy, daily functioning, and quality of life.

Conclusion: Caregiver rating bias can be attributed to caregiver burden. When caregiver burden is present, data based on caregiver ratings should therefore be interpreted with caution.

Keywords

Alzheimer's diseasemild cognitive impairmentcaregiveranosognosiarating discrepancydyadic data
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 8: Elder abuse an international perspective , August 2013 , pp. 1345 - 1355
Copyright
Copyright © International Psychogeriatric Association 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, DSM-IV-TR. Washington, DC: American Psychiatric Publishing, Inc.Google Scholar
Argüelles, S., Loewenstein, D. A., Eisdorfer, C. and Argüelles, T. (2001). Caregivers’ judgments of the functional abilities of the Alzheimer's disease patient: impact of caregivers’ depression and perceived burden. Journal of Geriatric Psychiatry and Neurology, 14, 91–98. doi:10.1177/089198870001300402.CrossRefGoogle ScholarPubMed
Braun, M., Scholz, U., Hornung, R. and Martin, M. (2010). Caregiver burden with dementia patients. A validation study of the German language version of the Zarit Burden Interview. Zeitschrift für Gerontologie und Geriatrie, 43, 111–119. doi:10.1080/13607860902879441.CrossRefGoogle ScholarPubMed
Burke, W. J., Roccaforte, W. H., Wengel, S. P., McArthur-Miller, D., Folks, D. G. and Potter, J. F. (1998). Disagreement in the reporting of depressive symptoms between patients with dementia of the Alzheimer type and their collateral sources. American Journal of Geriatric Psychiatry, 6, 308–319.CrossRefGoogle ScholarPubMed
Chang, Y. P., Edwards, D. F. and Lach, H. W. (2011). The collateral source version of the Geriatric Depression Scale: evaluation of psychometric properties and discrepancy between collateral sources and patients with dementia in reporting depression. International Psychogeriatrics, 23, 961–968. doi:10.1017/S1041610211000147.CrossRefGoogle ScholarPubMed
Clare, L. (2004). Awareness in early-stage Alzheimer’ s disease: a review of methods and evidence. British Journal of Clinical Psychology, 43, 177–196. doi:10.1348/014466504323088042.CrossRefGoogle ScholarPubMed
Clare, L.et al. (2011). The influence of psychological, social and contextual factors on the expression and measurement of awareness in early-stage dementia: testing a biopsychosocial model. International Journal of Geriatric Psychiatry, 27, 167–177. doi:10.1002/gps.2705.CrossRefGoogle ScholarPubMed
Clarke, D. E., Ko, J. Y., Kuhl, E. A., van Reekum, R., Salvador, R. and Marin, R. S. (2011). Are the available apathy measures reliable and valid? A review of the psychometric evidence. Journal of Psychosomatic Research, 70, 73–97. doi:10.1016/j.jpsychores.2010.01.012.CrossRefGoogle ScholarPubMed
Clyburn, L. D., Stones, M. J., Hadjistavropoulos, T. and Tuokko, H. (2000). Predicting caregiver burden and depression in Alzheimer's disease. Journal of Gerontology: Psychological Sciences, 55B, 2–13. doi:10.1093/geronb/55.1.S2.Google Scholar
Cohen, J. (1988). Statistical Power Analysis for the Social Sciences. Hillsdale, NJ: Erlbaum.Google Scholar
Conde-Sala, J. L., Garre-Olmo, J., Turro-Garriga, O., Lopez-Pousa, S. and Vilalta-Franch, J. (2008). Factors related to perceived quality of life in patients with Alzheimer's disease: the patient's perception compared with that of caregivers. International Journal of Geriatric Psychiatry, 24, 585–594. doi:10.1002/gps.2161.CrossRefGoogle Scholar
Cummings, J. L. (1997). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 48, 10–16.CrossRefGoogle ScholarPubMed
De Los Reyes, A. and Kazdin, A. E. (2005). Informant discrepancies in the assessment of childhood psychopathology: a critical review, theoretical framework, and recommendations for further study. Psychological Bulletin, 131, 483–509. doi:10.1037/0033-2909.131.4.483.CrossRefGoogle ScholarPubMed
Farias, S. T., Mungas, D. and Jagust, W. (2005). Degree of discrepancy between self and other-reported everyday functioning by cognitive status: dementia, mild cognitive impairment, and healthy elders. International Journal of Geriatric Psychiatry, 20, 827–834. doi:10.1002/gps.1367.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini Mental State”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. doi:10.1016/0022-3956(75)90026-6.CrossRefGoogle ScholarPubMed
Garand, L., Dew, M. A., Eazor, L. R., DeKosky, S. T. and Reynolds, C. F. (2005). Caregiving burden and psychiatric morbidity in spouses of persons with mild cognitive impairment. International Journal of Geriatric Psychiatry, 20, 512–522. doi:10.1002/gps.1318.CrossRefGoogle ScholarPubMed
Hautzinger, M. and Bailer, M. (1993). Allgemeine Depressions Skala. Göttingen: Beltz Test GmbH.Google Scholar
Hindmarch, I., Lehfeld, H., Jongh, P. and Erzigkeit, H. (1998). The Bayer Activities of Daily Living Scale (B-ADL Scale). Dementia and Geriatric Cognitive Disorders, 9, 20–26. doi:10.1159/000051195.CrossRefGoogle ScholarPubMed
Karlawish, J. H. T., Casarett, D., Klocinski, J. and Clark, C. M. (2001). The relationship between caregivers’ global ratings of Alzheimer's disease patients’ quality of life, disease severity, and the caregiving experience. Journal of the American Geriatrics Society, 49, 1066–1070. doi:10.1046/j.1532-5415.2001.49210.x.CrossRefGoogle ScholarPubMed
Lee, J., Koh, D. and Ong, C. N. (1989). Statistical evaluation of agreement between two methods for measuring a quantitative variable. Computers in Biology and Medicine, 19, 61–70. doi:10.1016/0010-4825(89)90036-X.CrossRefGoogle ScholarPubMed
Leicht, H., Berwig, M. and Gertz, H.-J. (2010). Anosognosia in Alzheimer's disease: the role of impairment levels in assessment of insight across domains. Journal of the International Neuropsychological Society, 16, 463–473. doi:10.1017/S1355617710000056.CrossRefGoogle ScholarPubMed
Logsdon, R. G., Gibbons, L. E., McCurry, S. M. and Teri, L. (1999). Quality of life in Alzheimer's disease: patient and caregiver reports. Journal of Mental Health and Aging, 5, 21–32. doi:10.1037/t00930-000.Google Scholar
Marin, R. S., Biedrzycki, R. C. and Firinciogullari, S. (1991). Reliability and validity of the apathy evaluation scale. Psychiatry Research, 38, 143–162. doi:10.1016/0165-1781(91)90040-V.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (2011). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology, 77, 939–939. doi:10.1212/01.wnl.0000400650.92875.cf.CrossRefGoogle Scholar
Morris, J. C. (1997). Clinical Dementia Rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. International Psychogeriatrics, 9, 173–176. doi:10.1017/S1041610297004870.CrossRefGoogle ScholarPubMed
Mortby, M. E., Maercker, A. and Forstmeier, S. (2012). Apathy: a separate syndrome from depression in dementia? A critical review. Aging Clinical and Experimental Research, 24, 305–316. doi:10.3275/8105.CrossRefGoogle Scholar
Mougias, A. A., Politis, A., Lyketsos, C. G. and Mavreas, V. G. (2011). Quality of life in dementia patients in Athens, Greece: predictive factors and the role of caregiver-related factors. International Psychogeriatrics, 23, 395–403. doi:10.1017/s1041610210001262.CrossRefGoogle ScholarPubMed
Pinquart, M. and Sörensen, S. (2003). Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis. Journal of Gerontology: Psychological Sciences, 58B, 112–128. doi:10.1093/geronb/58.2.P112.CrossRefGoogle Scholar
Radloff, L. S. (1977). The CES-D scale. Applied Psychological Measurement, 1, 385–401. doi:10.1177/014662167700100306.CrossRefGoogle Scholar
Ready, R. E., Ott, B. R. and Grace, J. (2004). Patient versus informant perspectives of Quality of life in mild cognitive impairment and Alzheimer's disease. International Journal of Geriatric Psychiatry, 19, 256–265. doi:10.1002/gps.1075.CrossRefGoogle ScholarPubMed
Rosenberg, P. B., Mielke, M. M. and Lyketsos, C. G. (2005). Caregiver assessment of patients’ depression in Alzheimer disease: longitudinal analysis in a drug treatment study. American Journal of Geriatric Psychiatry, 13, 822–826.CrossRefGoogle Scholar
Sands, L., Ferreira, P., Stewart, A., Brod, M. and Yaffe, K. (2004). What explains differences between dementia patients’ and their caregivers’ ratings of patients’ quality of life? American Journal of Geriatric Psychiatry, 12, 272–280.CrossRefGoogle ScholarPubMed
Schatzberg, K. L., Sudha, S. and Mutran, E. J. (1998). Elder-proxy agreement concerning the functional status and medical history of the older person: the impact of caregiver burden and depressive symptomatology. Journal of the American Geriatrics Society, 46, 1103–1111.Google Scholar
Schoenmakers, B., Buntinx, F. and Delepeleire, J. (2010). Factors determining the impact of care-giving on caregivers of elderly patients with dementia. A systematic literature review. Maturitas, 66, 191–200. doi:10.1016/j.maturitas.2010.02.009.CrossRefGoogle ScholarPubMed
Schulz, R.et al. (2013). Magnitude and causes of bias among family caregivers rating Alzheimer disease patients. American Journal of Geriatric Psychiatry, 21, 14–25. doi:10.1016/j.jagp.2012.10.002.CrossRefGoogle ScholarPubMed
Teri, L. and Truax, P. (1994). Assessment of depression in dementia patients: Association of caregiver mood with depression ratings. The Gerontologist, 34, 231–234. doi:10.1093/geront/34.2.231.CrossRefGoogle ScholarPubMed
Winblad, B.et al. (2004). Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240–246. doi:10.1111/j.1365-2796.2004.01380.x.CrossRefGoogle Scholar
Yesavage, J. A.et al. (1983). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatry Research, 17, 37–49. doi:10.1016/0022-3956(82)90033-4.CrossRefGoogle Scholar
Zanetti, O.et al. (1999). Contrasting results between caregiver's report and direct assessment of activities of daily living in patients affected by mild and very mild dementia: the contribution of the caregiver's personal characteristics. Journal of the American Geriatrics Society, 47, 196–202.CrossRefGoogle ScholarPubMed
Zarit, S. H., Reever, K. E. and Bach-Peterson, J. (1980). Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist, 20, 649–655. doi:10.1093/geront/20.6.649.CrossRefGoogle ScholarPubMed